Unifying Our Fragmenting Society – “Who Cares?”

In his recent blog post, “How Do You Get the U.S. off Life-Support?” (referring to the growing incivility in public discourse that has been exacerbated by the examples set before us during this most recent election cycle), Paul Louis Metzger (disclosure: Dr. Metzger is my faculty mentor in my doctoral program) notes the position taken by Dr. Robert Potter (again, disclosure: Dr. Potter is the other academician reader of my dissertation/ministry project paper). Drawing an analogy to palliative care (seeking to alleviate a patient’s symptoms and pain, separate from addressing curative measures), Dr. Potter seeks a solution to the pressing question, “What needs to be done?” by framing the questions “What am I missing?” and “Who am I missing?” These are essential questions. In pain management and end-of-life care, the holistic approach to the mental, emotional, spiritual, and social dynamics of the patient and their family can often be even more important than the physical processes being treated.

As I have written elsewhere, addressing these multiple areas of concern is difficult, requiring in hospice care an interdisciplinary team that (by law) must at least include a physician, a medical social worker, and a pastoral counselor/chaplain in addition to the hospice manager. The intensive and extensive level of care provided through hospice during the final weeks and months of life is nearly impossible to provide elsewhere. Likewise, it often may seem as though the answers to “What am I missing?” and “Who am I missing?” are not only daunting in the depths of their complexity, they may be endless in breadth. It may seem impossible to determine, much less include all that is missing, and all who are missing from the equation. In such cases, we may be tempted to take license to disengage from the process, allowing ourselves the escape clause: “We’ve done all that we can do.”

Why would I demand of us that we try any harder than that—either in treating a dying patient or in seeking to bring unity to a fragmenting society? Because I believe that beneath the questions “What am I missing?” and “Who am I missing?” lies a motivation that is, in my experience, so often unclear in both discussions. The question “Why is this pursuit so terribly important to you?” might be boiled down cynically to “Who cares?” But whether conservative or liberal, whether focused more exclusively on any few or encompassing all the “moral intuitions” that Dr. Potter cites (care, fairness, liberty, loyalty, authority, and sanctity), the answer is simply this: “You care.” For different reasons, at different levels, and from sometimes vastly divergent perspectives, it is impossible to deny that we have clear and passionate positions on most of the issues being discussed.

If you doubt whether you have such passions, simply put yourself in the place of those who are adversely affected by any of the issues. Start by asking yourself what levels of pain relief and symptom management (think uncontrollable nausea, for example) you would be willing to forego if your hospice team needed to cut back on their agency’s overtime. Questions of healthcare rationing may bore you. But faced with a decision on whether to pursue expensive treatments that have only the most miniscule chance of curing your disease? You may find yourself paying closer attention to the discussion.

The unifying issue for many participating in hospice care, as providers as well as for patients and their families, is that we generally acknowledge the reality of mortality. We not only provide care to the dying and bereaved, we number ourselves among them. Even when we are not among the most imminently dying, we willingly bereave ourselves, intentionally forming close personal friendships with people we know are going to die soon. The unity we find in that mutual mortality and shared grief allows us to discuss matters that nearly all others in our circles of influence work hard to avoid. (Most of them wish that we would avoid those topics, too.) But in caring about the issues, despite divergent positions, relative to hospice care, we are unified by our commitment to solidarity with and around the patient and their soon-to-be-bereaved family, knowing that we eventually will be one or the other or both.

So next, in the broader conversation about our national priorities, I would ask that you think about liberties you particularly enjoy. Would you care if they were being as maligned and restricted as those of others? Try considering your economic well-being threatened by those who would re-zone their neighborhoods to eradicate “your kind.” Imagine your religious affiliation (or lack thereof) as a reason to discredit and persecute you. And visualize yourself amidst the confrontation that would occur if armed authorities denied you your right to express your position on these or any other matters. You do care…if it’s your ox that’s being gored.

We all care. We merely subvert our engagement of these issues behind a pretense of apathy. Apathy, the lack of caring, is not what I find to be the cause of inaction. Instead, we choose not to engage on the basis of what I would call the economy of futility. We do not invest in solutions because we believe the problems to be insoluble. Therefore, we fail to recognize the undeniable unity of our concerns. At their core, our conflicts are universally compelling, if only we would admit how much we care about our own positions on the issues.

Will we agree on these positions? If you demand that I agree with your position, or I demand that you agree with mine, probably not. But we must agree, if we will admit that these are issues on which we each cannot help but have positions. Then, and perhaps only then, we might be willing to listen, understand, and collaborate in ways that resolve our conflicting positions on the issues themselves. Only then can we claim that “we’ve done all that we can do.”

Life-and-Death Differences: How do I know whether I need Hospice, Palliative Care, Terminal Sedation, or Physician-Assisted Suicide?

Doesn't it seem like there should be
at least one more option than this?

Those of us who discuss dying on a regular basis sometimes forget that terms we use very specifically can have a much broader range of meaning for most other (i.e., “normal”) people. For example, grieving, mourning, and being bereaved are often used interchangeably as synonyms (i.e., words with essentially the same meaning). Is it helpful to identify the particular definition of each one? I believe it is, especially for those who are experiencing all three simultaneously, and trying to find a safe course to navigate through them. Technically, then, but briefly: Bereavement = the condition of having experienced a significant loss. Grief = the involuntary reaction we experience when we are bereaved. Mourning = the voluntary actions we take that help to process our grief.

Vocabulary for the Dying

If the terms describing the experience of loss and its aftermath are important to distinguish from one another, then it is even more important to do so when the terms apply to our own experience as an imminently dying patient. Most of us would like to know only what it means to have symptoms, receive a diagnosis, follow a course of curative treatments, and be restored to health. And yet, the reality is that most of us, either in our own life or the lives of those closest to us, will hear some form of that dreaded sentence from our doctors: “I’m sorry. There’s nothing more we can do to make you well.” What are we supposed to do when “there’s nothing more we can do?”

The important distinction, even when you are diagnosed with a terminal disease, is that while there is nothing else to be done that will cure you, there is far more that can be done to ensure that you continue to live the best possible life until that terminal disease (or some other cause) ends your life. The next step, especially for those whose terminal or chronic illness is likely to end their lives within six months or so, is usually a referral to “Hospice.”

Well, this is a third option, but it's not exactly
what hospice care is all about.

Hospice: What it is, and why.

The best definition of hospice says more about what it is not than what it is. “Hospice exists not to prolong your life, nor to hasten its end, but to help you live until you die.” When curative measures are no longer possible, or desirable (since some patients find the treatments more difficult, debilitating, or even deadly than the disease), hospice can provide patients with symptom-management and pain relief throughout the natural, physical process of dying. But just as importantly, and sometimes more so, hospice provides support for the mental, emotional, social, and spiritual needs of the patient, their family, friends, caregivers, and others. The focus on a patient’s personal preferences includes determining how best to provide service in either the patient’s home or in a medical facility. The support for the many peripheral needs can include discussions with insurance providers, referrals to funeral planners, and coordination with the appropriate faith communities for spiritual support as well.

Why am I so concerned that you understand what hospice is and does? First, you or someone you know will likely need hospice services someday. Second, there are other alternatives becoming more popular, primarily because people are unaware that hospice care is available to them. And third, I want you to understand what hospice is and does because I hear too often, “If we’d only known everything hospice could do, we would have called you in much earlier.” Sadly, I also have to hear people say, “I wish we’d known about hospice when our loved one was dying.”

At least when it's prescribed in California,
it still has to be suicide, not homicide (so far).

“Turn Out the Lights; the Party’s Over”

To fully understand what hospice is and does (and isn’t and doesn’t), there is another pair of terms that are often confused (Palliative/Terminal Sedation and Physician-Assisted Suicide), and a third (the Dual Effect) that needs to be clarified as well.

These distinctions are very important, especially for those exposed to recent references in popular Christian books. In Rob Moll’s The Art of Dying, he quotes from Dallas Willard’s The Divine Conspiracy (before repeating the phrase as his own perspective) to portray hospice as employing “the widespread use of heavy sedation.” No wonder, then, that some patients, friends, and family members imagine that once hospice service begins the patient’s conscious existence becomes a thing of the past. But in actual practice, even what is called the “dual effect” of a patient becoming unconscious (or dying) as a side-effect of sufficient doses of pain medication is rare. When it does occur, it results from attempts to relieve distressing symptoms and/or unbearable pain. Further, it is almost exclusively occurring at the very end of a terminal illness’s progression. And yet, even when diseases have done nearly all they can do to us, hospices routinely accommodate the preferences of patients who, willing to endure higher levels of pain than others might, want to stay as awake and alert as possible. This is sometimes a temporary preference that allows, for example, one last visit with distant relatives or friends, and sometimes a distinct desire to experience as much as possible of the life remaining to them.

But there are, occasionally, physical symptoms that are “intractable.” Sometimes the extraordinary panoply of medications and techniques available are unable to provide the level of symptom management and/or pain relief that the patient desires. Palliative/Terminal Sedation (usually referred to as either Palliative Sedation or Terminal Sedation) is necessary for those patients who can only be made comfortable by rendering them unconscious. This is “palliative” in that it is a means of relieving pain and/or other symptoms. It is “terminal” because, unless there are measures to provide nutrition and hydration (food and water) artificially, the patient does not regain consciousness. Death occurs within a matter of days once there is no further fluid intake.

Is Palliative/Terminal Sedation, then, a form of Physician-Assisted Suicide? Some would see any claim to a difference between them as merely splitting hairs. In practice, however, there is a vast difference between the prescription of pain relief that may result in diminished or lack of consciousness (as can be a side-effect of effective Palliative Care), the prescription of unconsciousness as the only means of relieving pain (Palliative/Terminal Sedation) and the proactive ending of one’s life in order to preemptively avoid whatever symptoms may or may not accompany the progression of a terminal disease (Physician-Assisted Suicide).

So, we have made some progress.
(In grammar, punctuation and spelling, too, it seems.)

One Last, Unfortunate Distinction

While all hospices provide palliative care (relieving pain and symptoms), not all palliative care should be confined to hospice. There are patients for whom symptom-management and pain-relief should be provided, even as they pursue curative care. This is not currently the case for most patients. There are hopes for change, and some signs of progress. But currently both public and private insurers are hesitant to cover palliative measures for non-terminal patients. Still, palliative specialization in the medical community continues to be developed in anticipation of one day overcoming the legislative and regulatory roadblocks to a more enlightened public policy.

This bears careful attention as the push toward suicide continues to grow (as with California’s recent passage of the End of Life Options Act). If our society continues to advocate for hastening the deaths of the terminally ill, we are morally obligated to allow all patients the option of pursuing a cure for their disease and the restoration of their health. Unfortunately, patients too often abandon that curative care due to the debilitating side-effects or devastatingly difficult life-adjustments necessitated by otherwise effective treatments. As the proponents of Physician-Assisted Suicide disregard hospice, offering instead a “get well or die” paradigm, every opportunity should be provided to those patients who would seek to get well, were they not asked to endure torturous treatments unmitigated by palliative care.

What’s in a Name: Learning Advocacy from the Opposition

During the most recent conference of the California Hospice and Palliative Care Association (CHAPCA), much of the discussion centered on the recent success of a group now called “Compassion and Choices.” They were repeatedly referred to as “the most effective advocacy organization ever seen.”

They are advocates. They are effective. And they don’t mind making it clear that they are opposed to the current options available: either curative (seeking to restore the patient to health) or palliative (seeking to relieve the dying patient’s symptoms).

How effective are they? So much so that in a presentation on how to construct policy relative to California’s new law facilitating physician-assisted suicide, the spectrum of attitudes was described at one end as “embracing” the practice of self-administered euthanasia, while the other end of the spectrum was labeled “denial.” Now, most of us can imagine that “embracing” is a good thing. And even outside the ranks of those who work most closely with the dying and bereaved, you may be aware that “denial” is considered inevitable, but only as a temporary measure to buffer the sudden realities of crisis, trauma, or loss.

"The Death of Socrates"
by Jacques-Louis David

How opposed is Compassion and Choices to the status quo? Their six objectives (found here) include pursuing legislative innovations, exerting influence over medical professions, and establishing a litmus test for elected officials in making “aid in dying…a prime motivator in voter decision-making.”

But the most telling of their objectives is to “Normalize accurate, unbiased language throughout the end-of-life discussion (‘aid in dying’ instead of ‘assisted suicide’).” Taking them at their word, the intent here is insidious. While California has become the sixth state to legalize physician-assisted suicide (with legislation pending in at least fifteen others among these United States), the eventual goal is to allow active euthanasia—the proactive intervention by doctors and other in ending the lives of others, which under European health-care practitioners often occurs without the patient’s consent (noted here).

The word “semantics” signifies the art of choosing proper terminology to convey specific meaning. The term also gets used to describe those same talents when being used to obscure and mislead as well. With Compassion and Choices, however, the only word-games of which they could be accused involve being so clear as to be incredible. That is, thinking “I must be reading this wrong” would be a reasonable response to their desire for “accurate, unbiased language.”

A close-up view of Socrates.

You see, part of the argument against physician-assisted suicide is that of “the slippery-slope.” Some worry that if we allow patients to use physician-prescribed medications to end their own lives, it is only a matter of time before we move from describing “who could die, if their life is no longer of sufficient value to them” to prescribing “who should die, if their life is no longer of value to us.” The safeguard written into each state’s laws, so far, is that the patient must self-administer their own death. This is the essence of “assisted suicide,” that the means may be made available, but the final act to end a life should be taken only by the one whose life would be ended.

But the semantics are clear, and Compassion and Choices wants us to stop pretending that they mean anything other than what they say. They seek that we “normalize accurate, unbiased language” to communicate that their goal is something beyond what the current laws allow. Patients should receive “‘aid in dying’ instead of ‘assisted suicide.’”

Not Socrates. But you should still
take a close-up view.

Perhaps, though, the more accurate, unbiased name by which “Compassion and Choices” was previously known might help us understand their origins and intentions. When Derek Humphry, author of the infamous Final Exit (1984) which explored the field made more popular through the exploits of Dr. Jack Kevorkian, founded the organization, it was called “The Hemlock Society.” (The debate and decision to abandon the historic name is described here.)

Referencing as it does the story of Socrates, it might be good to remind ourselves of the Greek philosopher who was condemned to death and forced to drink hemlock, the deadly poison. Thus, as we face the continued efforts of “the most effective advocacy organization ever seen,” the chilling question we must face is this: “who will be making whom drink what?”

Where does this leave the student of effective advocacy? The mixed messages of what was until relatively recently The Hemlock Society, and has since become Compassion and Choices, make it difficult to adopt their strategies, even before issues of integrity, authenticity, and transparency eliminate them from consideration. An organization that promotes as a goal “to mean what they say” would, ironically, need to “say what they mean” just little more clearly, and certainly far more fully.

Otherwise, the only ones likely to drink their poison are those who fail to listen to them as carefully as we should.

A Cure Worse Than Death: The Failures Leading to Physician-Assisted Suicide

Do you want to die? Most reading this will, on most days, say no. But why? The reasons vary for each of us, but the strongest tendency is to imagine waking again tomorrow morning. How do I know? I’ve done it over twenty thousand times now. Maybe you’re only halfway or less to that number, but you have to admit, it’s habit-forming. So it is almost impossible for most of us to imagine, on most days, how someone might choose to break with such a long-standing pattern and to proactively end their lives.

But there are enough who do that our culture now embraces what was, until very recently, pushed to the margins, into the dark corners, out of polite conversation, and certainly against public policy. What had become an illegal cottage-industry leading up to the publication of Final Exit by The Hemlock Society and the media-celebrity of Dr. Jack Kevorkian, has now gained not only broader acceptance, but legal sanction in several states. The number of states establishing a “right-to-die” through Physician-Assisted Suicide (PAS) seems destined to grow until, eventually, some case or other prompts the U.S. Supreme Court to decree it as a constitutionally-protected right (as in 1954 – Brown v. Board of Educaction “legalizing” public school integration; 1973 – Roe v. Wade “legalizing” abortion; or 2015 – Obergefell v. Hodges “legalizing” same-sex marriage).

Understandably, some physicians see a patient’s decision to proactively hasten their end-of-life as representing a failure. So do I. But there are two different failures in view here. One of them is unavoidable. At some point, the tools, techniques, and therapies of modern medical practice fall short of restoring a patient’s health, or even of preventing that patient’s death. But while, in my life, there is still hope of the process accomplishing its stated goals, I am thrilled to have a primary-care physician who clearly states what steps are required to prolong and improve my life. I have known physicians, though, whose patients have died, despite efforts that should have prolonged or enhanced their lives. Sometimes, the medical system fails to keep a human’s physiological system functioning.

But there is a second failure in view when a patient chooses to proactively hasten the end of their life. Not that I am unsympathetic to the decision. In more than three decades of pastoral ministry, I have sat with enough patients and families to know how dreadfully difficult life can become, even with vitally-supportive faith communities being as attentive to their needs as possible. Still, even when the medical system announces “there’s nothing more we can do” (by which we mean “there’s nothing more we can do to cure you”), I do not support suicide, even if legally sanctioned and popularly recommended.

My belief in the sanctity of life extends from conception (and even prior to physical conception—given Jeremiah 1:4-5) to natural death. So, is the legislation sanctioning Physician-Assisted Suicide a failure of the Church’s emphasis on the sanctity of life. Perhaps to some extent. But only because we have failed to offer a viable alternative to torturous procedures. For some patients, we propose what they interpret as senseless dissection (surgery), systemic poisoning (many pharmaceuticals, including chemotherapy), and selective incineration (usually through radiation). We accept the cost-benefit ratio when there is an expectation of recovery, restoration, or at least slowing the dying process. But what about those patients for whom there is no longer any hope of cure, who see our role as merely prolonging a life of intensifying misery? The dichotomy routinely being presented to such patients is a false one, but it proves a compelling argument for many: “When the cures we offer are no longer effective, you deserve the right to have us kill you.”

The dichotomy (a choice between only two options) is a false one. But it is a pervasive one, nonetheless. Modern medicine routinely lives up to our expectation: “Cure me.” When we are beyond its best efforts, what do we then ask our doctor to do for us? If we imagine that we have no other options than to die painfully and protractedly, in a downward spiral of ever-decreasing self-determination and dignity, it may make sense to many to choose the only other option being so popularly promoted: Physician-Assisted Suicide.

So, the patient asks the medical community: “When you can no longer prolong mu life, are you willing to hasten its end?” The legal answer in a number of states is now, “Yes, we are. And yes, we will.” But before you or a loved one finds yourself facing that binary decision, the false dichotomy of choosing either “painful life or peaceful death,” consider that there may be other answers.

A small, and apparently invisible part of the medical community exists to serve a third purpose. Our goal is neither to prolong your life nor hasten its end. Providing pain-relief, symptom-control, and as much improvement in your quality of life as possible, the goal of hospice care is nothing more or less than to help you live until you die. Amidst a culture that will continue to gravitate toward offering just two options to dying patients, my hope is that you will at least discuss with us what we might be able to do for you, when you’ve been told “there’s nothing more we can do.”

"You matter because you are you, and you matter to the end of your life. 

We will do all we can not only to help you die peacefully, but also to live until you die."

— Dame Cicely Saunders, nurse, physician and writer, and founder of hospice movement (1918 - 2005)

“Who Is Qualified to Advocate for Me?” – On (Some of) the Frustrations of Mental Illness

(When you get tired of the whining, just jump to the paragraph after where it’s marked, “Here’s the important point.”)

I am tempted to joke, again, about the Ann Hedonia film festival. I could give you an imaginary roster of “famous film noir classics” in which the protagonist manages to maintain a dour demeanor of depressed indifference, even as tragically heroic actions preserve and protect others, without emotionally, mentally, socially, physically, or spiritually benefitting the movie’s central character.

Still, Ann Hedonia keeps making personal appearances, bringing her black dog along with her. And even though her roots are starting to show, that doesn’t stop her from bringing the twins out to offer their equally sour succulents, spines and all. She fulfills her usual typecasting, diminishing any desire to pursue otherwise enjoyable activities. But she’s expanded her repertoire to include a diminished enjoyment of even those activities I manage to pursue. In short, I don’t do fun stuff. And on those occasions when I do what used to be fun stuff, I don’t find it fun. And that’s before the black dog finds a quiet corner in which to do his business.

You won’t find her at IMDB (Internet Movie Data Base), and searching for her elsewhere may lead you to some very different conclusions than her personification of anhedonia, the inability to derive pleasure from otherwise pleasurable activities. As you can imagine, there is no fan club. (I think Sylvia Plath talked about maybe trying to organize something, but she doesn’t return my calls.)

If it seems that I am stalling, then you’re being perceptive. If you know me well, then you probably know that there have been good reasons to be, temporarily, sad. True, the San Francisco Giants are not in the playoffs, but it’s an odd-numbered year. And whatever business the Forty-Niners are pursuing is likely to self-correct, eventually. But some of you know about the long string of close personal deaths. Others are aware of the disappointing return on several deeply personal investments (involving the return of the abused to their abuser, the addict to their addiction, and the repeated disappearances of the purportedly devoted). There are other struggles that I pretend are invisible even to those closest to me. But the lie is wearing thin.

Yet all of you, I imagine—and, frankly, I myself—remain acutely aware of the many resources, benefits, and blessings not only available, but stocked deep in my personal inventory. And that’s where the key problem lies for many of us.

I perceive myself as having no standing from which to advocate for those experiencing mental illness. I am functioning, even as I find it difficult to have fun. (And I really do believe that fun is overrated as an evaluative category of life anyway.) Many others are struggling far more with far less ability to do anything about it. I can afford the counselor that I, until recently, avoided. I can adjust my diet and exercise in an attempt to foster endorphin production. (And I have, but it didn’t. Hence the counselor appointment.) There is no legitimate reason for me to be depressed—which further depresses me while simultaneously shaming me. No wonder I don’t get invited to many parties any more.

And yet, if I cannot speak about depression because I am not depressed enough, am I asking those who are more depressed than I am to bear the greater burden for communicating their needs? It would seem so.

But I was recently told that I could not advocate on behalf of a population whose status I do not share. The message was clear: those in need are the only ones with the right to speak of their need. But they don’t, any more than I willingly speak of my own minor difficulties. And yet, as those difficulties have worsened, I find that I wish someone else would advocate on behalf of this population in which I am numbered. Because I have been less and less willing to speak. In some ways, I feel like this post is something like a shout back toward town from edge of the growing chasm that threatens to swallow everything I know and love. I may not choose to say more.

Granted, the breaks between segments of the football game invite me to celebrate with them. McDonald’s now serves breakfast all day long (and the Twitter-pated are ecstatically emoji-ing over the news). Kia is finally building a vehicle for football families. The average military family can save over three hundred and forty-five million dollars by selecting USAA as their financial institution. And there are even more reasons coming at the next commercial break for celebrating life in these United States. But even in the face of these amazing developments, and “the power of Kaepernick” (in the words of the commentator enjoying the Niners’ quarterback as he leads the first sustained drive of the game), I find that my hopes, minimal as they are, rest…well, where? Not with me. Not with my self-help attempts. And not really with the counselor who comes so highly recommended.

But I am going. And I am hoping. Before it gets any worse. I think you should know why.

(Here’s the important point.)

This is why I am admitting my malaise, and moving toward the care I believe I need:

I recently heard a caregiver explain how strong they were, how much they were enduring, and how they would know when it was time for them to abdicate their role, turning the care of a loved one over to others. They expressed that they would not wait too long. When they were “ninety-nine percent done,” they promised, they would let others know to take up the slack of their absence.

My objection to their plan, as gently put as I knew how, was that when others have to respond, it would be good for there to be a little more than one percent of the caregiver’s attentions available, if for no other reason than to share with their replacement(s) what needed to be done in their stead. We agreed on eighty-five percent of their capacity as allowing enough time to make such a transition. But even at eighty percent, there is the possibility of crisis, of personal illness, or of any other unforeseen circumstances that might suddenly push them past their capacity. Engaging in some self-care in order to prolong their availability, and even to alleviate some of the pressure that has pushed them toward the end of their abilities, they may find themselves not only able to provide the care they want to give, but to be healthier in doing so as well.

If I, then, having advised others, choose to run my life too deeply into the high ninety percent range, then I am pretending that there will not be another string of close personal deaths, or other disappointments, or discord, dysfunction, or further debility among those I love. The reality is that I should expect more of the same. I serve a congregation where the average age is significantly higher than my own. The health of my immediate and extended family is unlikely to improve radically any time soon. Oh, and I continue to form close personal friendships with Hospice patients who are, by policy, supposed to be dying relatively soon.

So, before I use up too much more of whatever margin actually remains, I will be talking it over with a competent mental health professional. And if anything I have described in any of the above resonates with you, I pray that you do the same. But if you’re waiting for someone to advocate for you…I find that I can only advocate to you that you avail yourself of whatever resources you can.

The Expensive Habits of the Pure in Heart

Jesus said, “Blessed are the pure in heart, for they shall see God.”

I am not pure in heart. That should be noted immediately. Not that I don’t have my moments of altruism. I occasionally do the right thing for the right reasons. But short afterward, my retrospect-o-scope looks for ways in which I may have missed the potential profit, improved influence, or at least reputation-building benefits that could have accompanied my efforts.

So, when I am looking at even those few moments that some would imagine me pure in heart, what do I see? I see me. I see what resources I had available. I see what needs those resources met. I see my frustration at being unable to accomplish even more for those in need. And I see…well, the gratitude I think I deserve, the pay-back that should replenish whatever the particular act of service “cost” me, or even just the spiritualized brownie-points of somehow imagining that God is glad to have me on His team.

Let me illustrate my point by haunting you with the same story He haunts me with.

A servant rises before dawn. He attends to the household chores before sun-up. The master wants breakfast. So the servant cooks. Then serves the food. Then clears away the remainder. Then does the dishes. And then, at first light, the heads out into the fields, knowing that the sun will set before the work there is done. But after finding the way back to the house in the dark, the servant finds the master waiting. No small talk. No offer of cool water at the end of a hard day. The master wants dinner. So the servant cooks. Then serves the food. Then clears away the remainder. Then does the dishes. And then the servant makes the fire, checks the doors, sweeps and mops and ensures that the house is pristine before the master awakens again tomorrow morning, and the same cycle of service begins again.

Jesus uses a very similar illustration in Luke 17:7-10. Here’s how that concludes in the New American Standard translation. “So you too, when you do all the things which are commanded you, say, ‘We are unworthy slaves; we have done only that which we ought to have done.’” (Luke 17:10)

At one point in my life, I thought that religion could be pursued as a hobby. And I still think that. I have plenty of (nominally—meaning they claim the title, whether or not they have any idea about what it means) Christian friends who do just that. One occasionally tells me, “Yep, you’ll see me in church Sunday. Time to get my batteries recharged.” Some hobbyists think they can buy God off with an hour or two here or there. Others find the self-help lectures from the pulpit to be profitable, more or less. Too many feel the need to brush up on their proof-texts. Otherwise they may not know what to say when discussions turn to morality…of other people.

But what has made me dissatisfied with my hobby is what lies at the core of Jesus’ illustration in Luke 17:7-10. As grating as I once found that passage, I now count myself grateful for those moments, sometimes hours at a times, though hardly any full days (yet) in which I find myself being the single-minded servant He describes.

I used to look at God as that master who is unrealistically robbing his servant of any free time, making his life a drudge of routine, frustrated by never-ending chores to be done. Then I began to spend time with caregivers. Not always is it possible. But I have seen the closest family, and especially spouses, who serve the needs of a Hospice patient, a chronically-ill patient, or the disabled. Some leave home only to eke out the basic economic support of continuing their employment so that the insurance paying for their loved-one’s care doesn’t lapse. All the while they do so, knowing that eventually there will come those days when they return from work to find that there is no end to the work to be done at home.

What is the difference between their attitude and that of others who see Jesus’ demands eating into “their spare time?” They serve because it is the most authentic expression of who they are in relation to the patient. And because they know that, one day, the time for such loving service will be ended. Those who have been relieved of that duty almost unanimously wish for just one more day of it.

The more I recognize the purposes God is seeking to fulfill in and through my life (glorifying His name, so that the body of Christ is strengthened and made whole, so that the Church may tear down the gates of hell holding so many captive in the communities we are called to serve), the more I think fondly of the privilege of serving Christ and others. And the more I do that, the more I am reminded of another of Jesus’ teachings: “We must work the works of Him who sent Me as long as it is day; night is coming when no one can work.” (John 9:4-5)

When you see God, does it purify your heart? I believe it does. And I seek to purify my heart so that I might see God all the more. Except when I don’t. That is, when I begrudge Him the infringements on my “free time.” By which I mean: Whenever I forget that I am privileged to serve the One I love, and those whom He and I love together, and that the time remaining for doing so grows shorter every moment that passes.

Do you serve the Master? Good. Sacrificially sometimes? Probably better but, for me, that still means I’m looking at “my time” being given up for Him. So, I invite you to join me—to strive to serve your Beloved. You’ll find that to be far more fulfilling. 

Defining Bereavement, Grief, and Mourning…and the Blessings Therein.

Actually, I'm rethinking my epitaph.
It might read instead: "This machine is
temporarily out of order."

Most North Americans, in my experience, use the words Bereavement, Grief, and Mourning interchangeably. But some of us regularly discuss the experience of loss, its effects, and the means of processing its intrusion and integration into our lives. For specialists in Hospice and other fields like death education and grief counseling, there are important distinctions among these terms. I think that you may find these distinctions helpful, too.

Bereavement = having experienced a significant loss. Whether the life of a cherished loved one, a position of employment, a marriage, a child’s affections, or any other loss, being “bereaved” simply means, “I had this; now it’s gone.”

Grief = our reaction to bereavement. When we significantly value anything (whether positively or negatively), losing it upsets our sense of balance, order, and/or identity. The various elements of these reactions have been traditionally labeled within five categories. “Denial” is that buffer that allows us to process the loss in “bite-sized pieces.” “Anger” may be merely irritability for some, yet overwhelming rage for others, independent of what some might see as the “severity” of the loss experienced. “Bargaining” is our attempt to establish some argument or action that will change the reality of having experienced the loss. “Depression” often results when our mental, emotional, and physical energies have been nearly exhausted by the intensity, the hard work, of these reactions. “Acceptance” is that fluctuating state in which, I would hope, we are able to integrate the valued existence, of whatever we’ve lost, alongside the loss, of whatever existence we previously valued.

Mourning = our proactive response to grief. Most of us process our grief organically, independently, and successfully. Even when we find our way intuitively, though, we generally discover particular techniques that are especially helpful to us, and we practice them repeatedly as we “effectively mourn” the “authentic grief” that results from a “significant loss.” Some of us have specialized in discovering and developing as many of these methods as we can, and are available to help you when you feel “stuck” at some point, or find that some of your reactions are troubling and/or persisting. (If you find that you would like a referral for a grief counselor in your area, please send me an email at deathpastor@frontier.com.)

In addition to discussing death, dying, bereavement, grief and mourning, of course, as “Death Pastor” I also get the opportunity to discuss scripture, theology, and spiritual care just as regularly. In my tradition, as a theologically-conservative Christian, there is an assumption that the answer to every question is supposed to be “Jesus.” (A popular joke offers a Sunday School teacher asking, “I’m a furry gray creature with a bushy tail who lives in a tree. What am I?” After repeating the question twice and getting no response, he directs it toward his most promising student. She replies, “I know the answer is supposed to be Jesus, but it sure sounds like a squirrel to me.”) But as much as we might imagine that Jesus provides direct, even simplistic answers to all of life’s problems, when we actually read what He says, we find that He distinctly complicates our lives.

For example, Jesus says, “Blessed are those who mourn, for they shall be comforted.” (Matthew 5:4) In my context, I hear that as “Some of us more openly express and process the grief we feel over having experienced a significant loss. When we do so, we invite the compassionate response of those around us to provide whatever comfort they may have to offer.” Again, in my culture, that differentiation makes perfect sense. Many of us choose not to openly express and process the grief we feel. We do not openly mourn. (In fact, too few of us actually mourn privately, either. We follow the usual prescriptions to “get over it and get on with life,” to “be strong for the kids,” or simply to “get a grip.”)

In the testimonies of Jesus’ life and followers, though, there are several words with similar ranges of meaning to our “bereavement, grief, and mourning.” Yet Jesus chooses a word that incorporates all three elements: the experience of loss, the effects of that experience, and the expression of those effects. If I may take liberties to translate one word with three, “Blessed are the bereaved, grieving, and mourning.” Culturally, in what I read of first-century Palestine, there was no need for such careful delineation as I have to practice today. If you lost something, and especially a loved one, then you reacted to that loss and expressed it openly. This “mourning” of which Jesus is speaking is often contrasted with joy, happiness, and blessing. It is seen openly, and recognized, and attracts comforters…or at least fellow-mourners, even professionals who would weep and wail alongside the family and friends—but that’s another discussion for another time.

Are we willing to name our reality?

Where Jesus upsets His culture and mine is in saying “Blessed are those who mourn.” He does not say, “Those who mourn will receive a blessing by being comforted.” We are blessed while we are bereaved, grieving, and mourning. It is not that we will be comforted at some point in the future, but that we shall be comforted in the midst of, and as a part of the reality of our bereavement, grieving, and mourning. That’s not what we may want to hear. It may be very different from what we seek to provide to others, compassionately desiring to comfort them. But the complications Jesus causes are many and varied. This is just one of nine blessings Jesus describes in what are called “The Beatitudes.” (Matthew 5:3-12)

In The Beatitudes, Jesus speaks to His disciples about a realm of existence, the kingdom of God, that seems entirely upside-down to them. The poor, the mourning, the gently, the pure, the peacemakers, the persecuted…these are the marginalized, oppressed and exploited, those who many see as sub-human. Hardly blessed, at least in our eyes. But Jesus says they are blessed. Not will be, not have been, but are blessed. How? Because they recognize the reality to which so many others have blinded themselves.

The world lives in the midst of an incalculable loss. Every day, every life experiences the longing for that which we were created to be and to enjoy. The environment, the economy, our relationships, and our own minds and bodies—these and so many other evidences remind us that something is not quite right. In fact, it is far from being merely satisfactory. Just as there are alternatives to each of the other categories Jesus addresses in The Beatitudes, those who mourn are blessed because they can name the reality they see. We are bereaved. We grieve. We mourn. And we are comforted in knowing that there is hope for the broken and damaged world, just as much as there is for us as broken and damaged persons. But only if we stop refusing to see things as they are. Before we can get angry, or begin to bargain, or deal with our depression, we must overcome our denial.

We are broken. And blessed. Not just because Jesus said so. But because Jesus is here to say so, to us.

Simpson University: One More Friend on Hospice

Does anyone know where Dr. Dean filed the advance directives?

Just as with our electronic medical records at the hospital I serve, the email was automatically time and date stamped. We got the news at 10:22 p.m., Saturday, April 25, 2015.[1] It’s just a matter of time, now.

It troubles me more than most Hospice admissions. It’s not that my old friend’s treatments had failed. As much as she cried out for help to those from her church, the distance from Colorado Springs to Redding, California was apparently too great. She sought legal protections, but the courts said they feared to tread where angels stood helplessly by. Even those who once claimed to be her caregivers seemed only to see the estate she would leave behind. Specialists who may have had a renewing effect on her treatments? They never even visited the patient.[2]

At least the primary care provider, Dr. Betty Dean (board chair for Simpson University) understands the Hospice process.[3] Perhaps there will be some comfort-care provided as system after system, member after member, part after part continues to shut down. But I fear that as it is for so many physicians, the temptation to prolong the agony through artificial life-support will be too great. In this case, the toxic prescription will continue to be more loans, more buildings, more attempts to “grow ourselves” out of the deepening financial pit. As Dr. Dean told the family Saturday night, Dr. Dummer is tasked with increasingly “rapid advancement in our programs and growth in areas of high interest.”

My M.Div. graduating class from
A.W. Tozer Theological Seminary: 2012.

Where the personal pronouns and adjectives are so human (e.g., “we” have selected “your” president in order to advance “our programs”) an appeal to God’s will seems dissonant. That appeal becomes disastrously demented when it is presented as a panacea, a cure-all that overcomes all causes and symptoms, even the self-inflicted ones. Doing so while the heart and soul of this Christian community succumbs to the cancerous “business providing educational services” invites us to join in a delusion. We must decline.

Am I overestimating the disease process we’re seeing? I don’t think so. Certainly the Christian community recognizes the false hopes of futile treatments. The health-care proxy now appointed to oversee the patient’s final descent Dr. Robin Dummer. His doctoral dissertation covered the history of what is now Simpson University. He cites previous pronouncements of “God’s will” for Simpson that clearly echoed in Saturday’s announcement. Dr. Dean wrote, “We are pleased to follow that guidance [“God’s leading in the selection of your President”]…we move forward in the grace and power of our loving Saviour.” Dr. Dummer’s critique seems appropriate to both situations. He wrote, “the primary reason cited was God’s leading.” Then he added that “such an appeal to God as the decision-maker often mutes dissent[,] for how does one argue against God[?]”[4]

Tozer Seminary students at
Dr. Sarah Sumner's Installation Ceremony

Thankfully, Dr. Dean and her fellow board-members are not God, and we are still free to ask, “Could there still be some miraculous change in the patient’s condition?” It is a possibility. But the question is a little like asking, “Do some patients ‘flunk Hospice?’” And, to that question, the answer is Yes. With improved care and quality of life, with the withdrawal of debilitating treatments, and with the inaccuracies of medical prognoses, some patients rally and live far longer than one might imagine. Could that be the case with Simpson University, or even the Christian community within and around the university? Probably not. Here’s why.

The co-morbidities, the factors contributing to the decline and eventual death of this patient are severe, intractable, and being left untreated. One of those conditions is “philosophical dualism,” the idea that we can separate our “secular” lives from our “sacred” obligations. This infection eats away at the kind of dynamic Christian faith that would be necessary to the divine healing our friend so desperately needs. As that heart and soul erodes, even within the hollow shell of a “business providing educational services” the other disease continues to spread. “Reprehensible duplicity,” the practice of telling two (or more) complementary lies in hopes that neither will be effectively confronted, has pervasively endured treatments from both within and outside the organization.

A bunch of intensely Christian classmates during
"Intensives" during one of my master's coursework.
(I think it was the M.Min.P.C. at this point, maybe.)

So, this is the point at which most family members would ask, “How long does she have?” My personal experience as a Hospice chaplain leaves me opposed to prophesying in these cases. But I would offer a unique perspective on those matters that was shared with me some years ago.

I once served a patient whose multiple morbidities (and his doctors’ Latin phrases) had him confused about “How long do I have?” When he finally understood my translation of the most recent letter from the medical community he said, “So, the lung disease I’ve had would finish me off in about six years. But now I have cancer, and that’s going to finish me off in about six months. Just like, if I walk out onto the highway, I’d have probably no more than six minutes before the next logging truck came along.”

We laughed together then. And I wish I had his sense of humor now. But I find myself deadly serious about this.

To follow through on my friend’s metaphor, those of us who love the patient most should carefully consider whether we are being invited to sit vigil at the bedside, or to stand with the patient on the centerline of the highway. To use another frame of reference, I would never question those who have chosen, and those who may choose now to get off the ship while there (may) still be lifeboats available.

---

[1] This is the text of Dr. Betty Dean’s email from Saturday, April 25, 2015.

Dear Simpson Community,

The Board of Trustees of Simpson University wishes to thank all in the Simpson community who have prayed over the past weeks and months for God's leading in the selection of your President.

We are pleased to follow that guidance and announce the appointment of Dr. Robin Dummer to serve in leading the University as President.  Dr. Dummer's faithful service, understanding of the Simpson community, its culture and the institution's vision will allow for rapid advancement in our programs and growth in areas of high interest.

In addition to appointing Dr. Dummer, the Board acknowledges his most valuable service to the University during the past twenty-four months as Interim President.  With the strong support of the board, faculty, staff and administration, we have confidence that Dr. Dummer's leadership will serve the University well as we move forward in the grace and power of our loving Saviour.

With Gratitude to All,
Betty Dean, Chair
Board of Trustees

cc Board of Trustees

[2] Dr. Betty Dean, “Presidential Search Update,” faculty and staff emails, March 4 and 17, 2015.

[3] Dr. Betty Dean, personal conversations on her history of helping to found a local Hospice organization.

[4] Dr. Robin Dummer, Dissertation, quoted by Yvonne Comstock Wilber, Facebook comments, April 26, 2015.

Two Ways To Make Better Emergency Decisions – Part One: A Primer in Preparedness

If you had to leave the building right now,
where do you go?

“You should improve your impulse control.” Usually, that means restraining our impulsive purchases. Turn off the “one-click ordering,” don’t “stop by for your free test-drive,” and ignore everything offered you at the grocery store check-stand. Those are good steps to take, especially if you find that you’re headed toward an eventual storage locker rental.

But there are other impulses that are essential to our health and well-being. When backing out of a parking spot, or changing lanes in traffic, feel free to respond quickly to the sounds of beeping horns or shouting pedestrians. It’s appropriate to duck or turn in response to loud, sudden noises. Definitely dive for the toddler who’s managed to unbuckle the safety belt and stand up in the shopping cart. Don’t let those occasional spikes of adrenalin go to waste. React.

But not all our reactions are intuitively appropriate. That is, some impulses may not result in the best outcomes. The adrenalin rush fuels our need to fight, to flee, or to freeze. Sadly, though, it does not always lead us to choose correctly among those options. In an emergency, we often find ourselves needing to act without thinking through the potential consequences of our actions, and the results can be very different. For example, if the pedestrians shouting at you are warning of what you’re about to hit—the brakes are the better choice. If they’re warning of what’s about to hit you—you might want the accelerator.

The first of the “Two Ways To Make Better Emergency Decisions” is…

Prevent Emergency Decisions

Emergencies are an inescapable reality. There will be moments in which we need to act immediately in order to prevent damage or injury to others or ourselves. But even in those moments, we do not have to make emergency decisions, if we have already decided what we will do in case of a particular emergency.

Do yourself and your loved ones a favor:
complete and file your advance directives.

As a bank teller, I was trained and drilled in the actions to take in the event of a bank robbery. When a man leveled his pistol at me through the window one day, despite the adrenalin-fueled impulses I felt, I followed the protocol that we had practiced. The need to focus my mind on “doing this the way I was taught” helped prevent me from fighting, fleeing, or freezing. The correct response was to calmly follow-through on the requests made by the man holding the gun.

Later, though, as a police chaplain, I was reminded frequently of the potential risks of accompanying our officers into the field. One night on a hotel balcony, several occupants of a particularly rowdy room wanted to join the officer and me in the narrow, confined space outside their door. The officer repeated his request that only the one we were to contact should come out, until a young man inside the room called me by name. Inexplicably, the officer let him come out to visit with me. A moment after, when those inside the room decided that wrestling with an armed law enforcement officer seemed like a good idea, the young man of my acquaintance, now behind the officer, began to reach for the officer’s pistol. I remember thinking about my training, but I didn’t think about it until after I had taken the appropriate measures to restrain the subject.

I'm not sure "See Your Chiropractor"
belongs above "Notify Your Insurance
Company," but you get the idea.

Not every emergency involves firearms. But almost every emergency can be anticipated. The necessary decisions can be thought through, and preparations for various contingencies can often be made. In three very common situations, though, I find that there has been almost no forethought, much less preparation. Our fantasy is often that “we’ll never have to make that decision,” which we often phrase, “we’ll cross that bridge if we come to it.” Most of us will face a chasm or two like these in the course of our lives. Don’t wait until you’re there to realize that there is no bridge.

Childbirth Complications

We can spend most of an evening in some circles discussing, theoretically and hypothetically, “Do we believe that abortion should be an option if and when a mother’s life would be endangered by continuing to carry her as-yet-unborn child?” I’m sure there are plenty of interesting opinions we could share over dinner. But when the doctor says, “I can’t save them both. What do you want me to do?” the answer is time-critical. When our son was just about to become the subject of such a conversation, the doctor had already worked out the way he was going to phrase it. “I’m going to have to break him, or her, or both.” We were within thirty seconds of having to give him an answer. But since he was our third child, we’d had plenty of time and opportunity to discuss what we believed. We literally had the answer ready before (several years before) the doctor needed to ask the question.

Complications at the Other End-of-Life

There is almost no end to the research, education, and information available on the techniques and technologies that continue to complicate what has never been a simple subject: how hard do we want the medical community to work before they let us die? In polite company we might ask, “To which among the many life-prolonging therapies, procedures and medications would I feel comfortable submitting myself or a loved one? From which of them would I hope my loved ones protect me when I am no longer able to make my own wishes known?” This needs to be discussed in detail, and more frequently than you might think. New options are constantly becoming available. It would be good to hear about them from your doctor, at least sometime before he needs to turn to your assembled family and/or friends and ask, “What was her preference? Do we hook her up, or let her go?”

An excellent resource for putting together
your advance directives. 

Planning for Violent Crime

Would-be pacifist that I am, I frequently contemplate, and discuss as often as anyone will allow, “How do I feel about the terrible possibility that I might have to employ violence in response to violence toward myself? toward others? toward my loved ones?" The time to decide whether you’re willing to use force in response to force is before you ever face such circumstances. Simply put: hesitate in deciding and you might as well not decide. Even a momentary delay will usually prevent any subsequent action from being effective, no matter how extensive your planning and training may be. I mean to address here, however, only those momentary circumstances in which immediate action must be taken to protect yourself or others. In communities where law enforcement resources and responses are limited, these questions apply primarily toward criminal behaviors. For others, where law enforcement resources and responses are excessive, the same questions apply in our approach to law enforcement officers themselves. In both cases, however, advance preparation leads to more careful response, whether we choose to support, to obey, to resist, or even to confront those threatening violence.

In part two, I’ll discuss the second of the two ways to make better emergency decisions. Even more important that what we do ahead of a crisis is what we do amidst the crisis.

Why Ask? Because Sometimes the Question is Clearer than the Answer.

Jay Westbrook, portrait of his wife, Nancy, and the dogs.

Jay Westbrook recently led a session during the 2014 conference of the California Hospice and Palliative Care Association (CHAPCA). (You can read more about Jay's journey here: http://bigstory.ap.org/article/after-thousands-deaths-hospice-nurse.) As part of his presentation, he shared statistics relating to how patients would prefer to receive information from their care providers. Among the study results he shared was that 70% of elderly Koreans would prefer that their eldest son be the one to receive and then convey the details necessary. Later in the presentation he asked how we would convey bad news, for example, about the diagnosis, treatment results, and/or prognosis for an elderly Korean man. Some of us congratulated ourselves on our excellent short-term memory and began to explain a process by which the eldest son, or child, would be identified, contacted, and informed, all within the boundaries of HIPAA’s privacy regulations. After allowing us to work through the related issues, he asked, “But how do you know if that’s how the patient wants to get their information? What if they’re not part of the 70%? Because that statistic means that 30% of elderly Koreans want to get their news in some other way.”

During the exercise, I remember feeling a bit smug myself. I was recalling my studies under Jason Kim (a Korean pastor and church leader whose dissertation explored generational issues in the Korean church). Dr. Kim’s doctoral supervisor had been Paul G. Hiebert. I am indebted, as are the congregations and communities I have subsequently served, to both Dr. Kim and Dr. Hiebert for a number of things. The most influential factors are from Dr. Hiebert’s Understanding Folk Religion, which Dr. Kim applied to our tendency to make assumptions in various ministry venues.

Those issues have been especially helpful in two of my current ministry contexts. As a Hospice chaplain, for example, I sometimes deal with expectations and stereotypes about our patients, often based on evidence as scant as just one word. In the course of our admittance procedures, a patient may identify themselves as “Catholic,” or “Baptist,” or “Buddhist,” or any number of other labels. As a chaplain who frequently has no direct access to patients (for the reasons behind this, see my post, “Hospice Chapliancy – Equally Available and Avoided by Both Adherents and Atheists,” found here: http://deathpastor.blogspot.com/2014/10/hospice-chaplaincy-equally-available.html), I am occasionally asked “What do (insert spiritually identifying label here) believe about (insert ethical quandary or spiritual care issue here)?” so that our staff can provide appropriate support to the patient and family in those areas.

What Drs. Kim and Hiebert alerted me to, though, is that the label one chooses may not be as communicative as we imagine. Those who attend even the most rigidly dogmatic examples of particular religious traditions are often influenced by a number of other, outside, and perhaps incompatible beliefs and behaviors. We tend to compile and compress those influences in such a way that our religious preferences and practices may not reflect “what (we) believe about (whatever),” but a uniquely individual perspective instead.

Not a bad list to start with.

It is my primary ministry context where this factor is most acutely felt. In an independent, non-denominational community church (see www.glenburnchurch.com for some idea of who we are), visitors often ask us to label our particular tradition, branch, denomination, or other theological designation. Likewise, we sometimes hear from those attending that they are (label), as though that single word carries specific meaning for us. It doesn’t. And that is a very good thing. One of the reasons that we practice “theology in community” is that it can be both a means and an end to deepening our relationship with God through Christ. Learning how others understand beliefs and behaviors, both ours and their own, leads us into broadening and deepening our own understanding, also of theirs and our own, as well.

(This isn't how you should ask the questions, by the way.)

And so, during his conference presentation, I anticipated Mr. Westbrook’s question, and answer. Because the question “How do you know how a patient wants to receive their information?” should prompt the same answer as “How do you know what a Christian believes about baptism?” or “What does a Hindu believe about reincarnation?” or “Why does an atheist believe that there is no god?” The answer, I believe, should always be: “I don’t know. Ask the patient, the Christian, the Hindu, the atheist, or whomever else you want to know about.”

So, even when I am the one asking myself, “How do you know anything about others?” I try to remember: “I don’t know. So ask them.”